Page |1
AHIP Exam Practice Questions & Answers (2026–2027) Comprehensive Practice Bank —
Medicare Core Rules, Regulations & Fraud, Waste, and Abuse (FWA)
SECTION 1: MEDICARE BASICS & ELIGIBILITY (Parts A & B)
Question 1. Which part of Medicare covers inpatient hospital
stays, care in a skilled nursing facility, hospice care, and some
home health care?
A) Part A
B) Part B
C) Part C
D) Part D
Correct Answer: A) Part A
Rationale: Medicare Part A is specifically designed as hospital
insurance, covering institutional and inpatient care services such
as hospital stays, skilled nursing facility care, hospice, and some
home health services. Part B covers outpatient services, Part C is
Medicare Advantage, and Part D covers prescription drugs.
Question 2. To be entitled to Medicare Part A without paying a
monthly premium, how many quarters of coverage must an
individual or their spouse earn through payroll taxes?
A) 20 quarters
B) 30 quarters
, Page |2
C) 40 quarters
D) 50 quarters
Correct Answer: C) 40 quarters
Rationale: Individuals who have worked at least 40 quarters (10
years) in Medicare-covered employment do not have to pay a
premium for Part A. This is often referred to as "premium-free
Part A."
Question 3. What is the standard monthly premium for
Medicare Part B based upon?
A) The beneficiary's zip code
B) The beneficiary's modified adjusted gross income (MAGI)
C) The beneficiary's health status and pre-existing conditions
D) The number of years the beneficiary has been retired
Correct Answer: B) The beneficiary's modified adjusted gross
income (MAGI)
Rationale: Higher-income beneficiaries pay a higher Part B
premium based on their Modified Adjusted Gross Income,
known as the Income-Related Monthly Adjustment Amount
(IRMAA). Income, not health status or location, determines the
premium amount.
Question 4. Medicare Part B covers which of the following
services?
A) Inpatient surgery
B) Outpatient physician services and preventive care
, Page |3
C) Long-term custodial care in a nursing home
D) Routine cosmetic procedures
Correct Answer: B) Outpatient physician services and
preventive care
Rationale: Part B covers medically necessary outpatient
services, doctor visits, durable medical equipment, and
preventive care. Inpatient surgery is covered under Part A, and
custodial care and cosmetic procedures are generally not
covered by Medicare.
Question 5. What percentage of the Medicare-approved
amount does a beneficiary typically pay for Part B covered
services after meeting their annual deductible?
A) 10%
B) 20%
C) 30%
D) 50%
Correct Answer: B) 20%
Rationale: Under Original Medicare Part B, the beneficiary is
responsible for a 20% coinsurance after the annual deductible is
satisfied. This is a key cost-sharing feature of Original Medicare.
Question 6. What is another common name for Medicare Part C
plans?
A) Medicare Supplement Plans
B) Medicare Advantage Plans
, Page |4
C) Standalone Prescription Drug Plans
D) Medicaid Wrap Plans
Correct Answer: B) Medicare Advantage Plans
Rationale: Medicare Part C is officially known as the Medicare
Advantage program, which allows private insurance companies
approved by CMS to deliver Part A and Part B benefits.
Question 7. Which of the following is true regarding a
beneficiary enrolled in a Medicare Advantage plan?
A) They lose their Medicare rights and protections.
B) They must still pay their Medicare Part B monthly premium.
C) They no longer have coverage for emergency room care.
D) They cannot be billed any copayments or deductibles.
Correct Answer: B) They must still pay their Medicare Part B
monthly premium.
Rationale: To enroll and remain in a Medicare Advantage plan,
a beneficiary must continue to pay their Medicare Part B
premium to the federal government, unless the plan offers a
premium reduction benefit.
Question 8. Which federal program primarily provides health
coverage for people age 65 and older, as well as certain younger
individuals with qualifying disabilities?
A) Medicaid
B) Medicare
AHIP Exam Practice Questions & Answers (2026–2027) Comprehensive Practice Bank —
Medicare Core Rules, Regulations & Fraud, Waste, and Abuse (FWA)
SECTION 1: MEDICARE BASICS & ELIGIBILITY (Parts A & B)
Question 1. Which part of Medicare covers inpatient hospital
stays, care in a skilled nursing facility, hospice care, and some
home health care?
A) Part A
B) Part B
C) Part C
D) Part D
Correct Answer: A) Part A
Rationale: Medicare Part A is specifically designed as hospital
insurance, covering institutional and inpatient care services such
as hospital stays, skilled nursing facility care, hospice, and some
home health services. Part B covers outpatient services, Part C is
Medicare Advantage, and Part D covers prescription drugs.
Question 2. To be entitled to Medicare Part A without paying a
monthly premium, how many quarters of coverage must an
individual or their spouse earn through payroll taxes?
A) 20 quarters
B) 30 quarters
, Page |2
C) 40 quarters
D) 50 quarters
Correct Answer: C) 40 quarters
Rationale: Individuals who have worked at least 40 quarters (10
years) in Medicare-covered employment do not have to pay a
premium for Part A. This is often referred to as "premium-free
Part A."
Question 3. What is the standard monthly premium for
Medicare Part B based upon?
A) The beneficiary's zip code
B) The beneficiary's modified adjusted gross income (MAGI)
C) The beneficiary's health status and pre-existing conditions
D) The number of years the beneficiary has been retired
Correct Answer: B) The beneficiary's modified adjusted gross
income (MAGI)
Rationale: Higher-income beneficiaries pay a higher Part B
premium based on their Modified Adjusted Gross Income,
known as the Income-Related Monthly Adjustment Amount
(IRMAA). Income, not health status or location, determines the
premium amount.
Question 4. Medicare Part B covers which of the following
services?
A) Inpatient surgery
B) Outpatient physician services and preventive care
, Page |3
C) Long-term custodial care in a nursing home
D) Routine cosmetic procedures
Correct Answer: B) Outpatient physician services and
preventive care
Rationale: Part B covers medically necessary outpatient
services, doctor visits, durable medical equipment, and
preventive care. Inpatient surgery is covered under Part A, and
custodial care and cosmetic procedures are generally not
covered by Medicare.
Question 5. What percentage of the Medicare-approved
amount does a beneficiary typically pay for Part B covered
services after meeting their annual deductible?
A) 10%
B) 20%
C) 30%
D) 50%
Correct Answer: B) 20%
Rationale: Under Original Medicare Part B, the beneficiary is
responsible for a 20% coinsurance after the annual deductible is
satisfied. This is a key cost-sharing feature of Original Medicare.
Question 6. What is another common name for Medicare Part C
plans?
A) Medicare Supplement Plans
B) Medicare Advantage Plans
, Page |4
C) Standalone Prescription Drug Plans
D) Medicaid Wrap Plans
Correct Answer: B) Medicare Advantage Plans
Rationale: Medicare Part C is officially known as the Medicare
Advantage program, which allows private insurance companies
approved by CMS to deliver Part A and Part B benefits.
Question 7. Which of the following is true regarding a
beneficiary enrolled in a Medicare Advantage plan?
A) They lose their Medicare rights and protections.
B) They must still pay their Medicare Part B monthly premium.
C) They no longer have coverage for emergency room care.
D) They cannot be billed any copayments or deductibles.
Correct Answer: B) They must still pay their Medicare Part B
monthly premium.
Rationale: To enroll and remain in a Medicare Advantage plan,
a beneficiary must continue to pay their Medicare Part B
premium to the federal government, unless the plan offers a
premium reduction benefit.
Question 8. Which federal program primarily provides health
coverage for people age 65 and older, as well as certain younger
individuals with qualifying disabilities?
A) Medicaid
B) Medicare
